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Monday, January 05, 2009

RECOMPOSIZE TESTIMONIAL FORM

Name Age Male Female

Length of time taking Recomposize Months

Did you take your body measurements before starting Recompozise? Yes No

If "Yes"how many total inches have you lost thus far? inches lost

Using a grading scale of 1 thru 10 (1 being the lowest and 10 being the highest) please indicate the changes you've noticed in the chart below while taking Recomposize.

	Before Recomposize	After Recomposize
General Cravings/Desire for "Junk Foods"
Overall Amount of Food Consumption
Sweets/Carb Cravings/Consumption
Stress levels
Mental Focus/Concentration
Energy Levels
Generalized Feeling of Well-being
Quality and Length of Sleep

In your own language, please describe the positive changes you’ve noticed while taking Recomposize:

CUSTOMER TESTIMONIAL/ENDORSEMENT RELEASE

I hereby give Health Thru Nutrition (the "PUBLISHER"), the right and permission, with respect to any photograph(s) taken of me or in which I may be included with others, direct quotes or
portions of direct quotes made by me or all or any portions of statements, details, events or recountings of events in which I participated (the "MATERIAL"): (a) to copyright the same in PUBLISHER'S own name or any other name that the PUBLISHER might choose; (b) to
use, re-use, publish or re-publish the same in whole or in part, individually or in conjunction with other similar MATERIAL, in any medium, including (but not by way of limitation) illustration, promotion and advertising, and trade; and (c) to use my name in conjunction therewith
if PUBLISHER so chooses.

I hereby waive any right that I may have to inspect or approve the finished product or products or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied.

I hereby release PUBLISHER from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form that may accidently occur in the reproduction, use, processing, printing 
or publication of the MATERIAL.

I hereby warrant that I am of full age, or that if I am a minor that I and my legal guardian have every right to contract in my name
in the above regard. I further state that I have read this RELEASE prior to its execution, and that I am fully familiar with its
contents.

Date
Your legal name
Phone number

Your address
Street
City
State
Zip Code

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